Changing reimbursement models requires changes to physician compensation models – basics

The public and private markets are moving to outcomes-based reimbursement and while many provider organizations are signing risk-based contracts, they have not realigned the physician compensation model. The conundrum – the organization is reimbursed to manage costs and utilization but the physicians are compensated based on volume (production). Currently, only 3% of physician compensation models […]
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Positioning for continued growth in public exchanges

With four million people enrolled in public health exchanges as of the end of 2014, most payers competing in federally facilitated marketplaces or state-based exchanges have moved beyond the initial stages of implementation and are envisioning taking their plans to the next level. This “next level” means delivering more consumer-oriented offerings and engagement approaches, with […]
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Rethinking your MMIS? A services-only approach does qualify for enhanced FFP.

Many people have asked whether a service-based model for Medicaid Management Information System (MMIS) qualifies for enhanced federal funding. The answer is yes. As you know, the federal government requires states to undergo certification to receive enhanced Federal Financial Participation (FFP), which pays 90 percent for MMIS implementation and 75 percent for ongoing operations. What […]
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Plans should take full advantage of technology, operations to manage exchange markets

As Affordable Care Act (ACA) exchange markets evolve, health plans managing these markets face certain realities: many exchanges have not functioned as anticipated, technology has not always panned out, pricing often has been driven by poor data and inadequate risk assessment, and the market has been in a state of flux. However, during the transition […]
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Transforming a high-stress work environment into a culture of health

Look around your organization. Are your employees and managers: Jumping from meeting to meeting, racing through their days? Eating lunch at their desks and taking few breaks? Rarely taking vacations? Answering emails on nights, weekends and holidays? These may be symptoms of a stressful work culture. And that’s something you want to address. Chronic stress […]
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CMS is incentivizing providers to participate in its value-based care programs

The organizations who will likely thrive as health care shifts to fee-for-value payments are those who aggressively embrace the changes. Both the Centers for Medicare and Medicaid Services (CMS) and Congress have sent strong indications recently that the primary engine for future health care reforms will be quality rather than quantity. And based on the […]
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Easy does it: Transitioning your employees to consumer-driven health care

You’ve done it. You’ve decided to transition your health plan offering from a traditional preferred provider organization (PPO) to a qualifying high-deductible health plan (HDHP) with a health savings account (HSA) or health reimbursement account (HRA). You’re not alone. Each year, more employers recognize consumer-driven health care (CDH) as a way to keep benefit costs […]
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Evaluating effectiveness of your organization against best practices for risk adjustment and quality programs

Whether it’s to reduce medical loss ratios or improve competitive positioning with more affordable products, health plans are under increasing pressure to reduce medical expenses through population health management. Where do you start when it’s difficult to identify and prioritize areas of opportunity that will have the greatest impact? A critical first step is to […]
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What does the latest data from CMS mean for Medicare accountable care organizations?

The numbers coming out of the Centers for Medicare and Medicaid Services (CMS) tell an encouraging story about the prospects for Medicare Accountable Care Organizations and the Medicare Shared Savings Program. According to a CMS report, 243 ACOs saved Medicare $877 million in an 18-month span that ended in 2013. While that is only less […]
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Podcast: Using predictive analytics to improve care quality

Being proactive about providing care for patients is an important strategy for quality improvement. Once a patient presents at the point of care, especially a high-risk patient, the time for prevention has passed. Reaching out to such patients before they feel like they need to go to the hospital is the key. In this edition […]
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